Kyphoplasty
A minimally invasive cement procedure to stabilize and restore height in vertebral compression fractures
Kyphoplasty is a minimally invasive procedure that treats painful vertebral compression fractures — most commonly caused by osteoporosis, but also by cancer or trauma. Through small skin punctures, the surgeon inserts thin tools into the collapsed vertebra under X-ray guidance, inflates a balloon to restore vertebral height and create a cavity, then fills the cavity with bone cement to stabilize the fracture. Kyphoplasty is closely related to vertebroplasty (which does not use a balloon and does not attempt height restoration); the balloon step is the key distinguishing feature. The procedure addresses pain from the unstable fracture immediately — most patients experience significant pain relief within 24–48 hours and walk the same day.
Who Is a Candidate?
- Painful vertebral compression fracture from osteoporosis that has not improved after 4–6 weeks of conservative care
- MRI-confirmed acute or subacute fracture (bone marrow edema present, typically <6–8 weeks old)
- Cancer-related vertebral fracture (metastatic lesion causing painful collapse)
- Fracture causing significant height loss or progressive kyphotic deformity
- Significant pain limiting mobility — bed rest increases osteoporosis and fracture risk; early mobilization via kyphoplasty is beneficial
What to Expect
1Before Surgery
MRI is mandatory to confirm the fracture is acute — chronic fractures without bone marrow edema rarely respond to kyphoplasty. CT may be performed to assess fracture anatomy. Blood thinners (aspirin, warfarin, clopidogrel) must be stopped 5–7 days before the procedure. Fasting is required if sedation or general anesthesia is used. The procedure is performed outpatient in the majority of cases.
2The Procedure
You lie face-down on the fluoroscopy table. After skin numbing and sedation or light general anesthesia, the surgeon uses live X-ray guidance to insert a trocar (hollow needle) into the fractured vertebra through a small skin puncture on each side (bilateral approach). A balloon tamp is advanced through the trocar and slowly inflated to create a cavity and attempt to restore vertebral height. The balloon is deflated and removed. Bone cement (polymethylmethacrylate, PMMA) is injected under low pressure to fill the cavity. The cement hardens in minutes, permanently stabilizing the vertebra. The procedure takes 45–60 minutes for one to two levels.
3Recovery
Most patients are observed for 1–2 hours and discharged home the same day. You can walk immediately after the procedure. Pain relief typically begins within 24–48 hours as the cement stabilizes the fracture. Bed rest is not required or recommended — early gentle activity is encouraged. You may return to light daily activity within 2–3 days. Formal physical therapy (balance, gentle strengthening, fall prevention) typically begins after acute pain resolves. Heavy lifting and high-impact activity are restricted for 6–8 weeks.
Typical Outcomes
80–90% of appropriately selected patients — those with acute fractures confirmed by MRI — report significant pain reduction after kyphoplasty. Relief is typically durable because the cement is permanent. Vertebral height restoration averages 30–50% of lost height, which may partially correct kyphotic deformity and improve posture. Multiple randomized controlled trials demonstrate that kyphoplasty provides faster and greater pain relief than conservative management for acute osteoporotic fractures. Outcomes are significantly better for acute fractures than for chronic (>3 months) fractures.
Risks & Considerations
- Cement leakage (extravasation) — occurs in 5–10% of cases; most are asymptomatic but leakage into the spinal canal can cause nerve compression (rare)
- Adjacent vertebral fracture — 5–10% risk in the first year; the treated vertebra becomes rigid while adjacent osteoporotic vertebrae bear altered load
- Infection at the puncture site (<1%)
- Pulmonary cement embolism — rare but serious; cement enters venous circulation and travels to the lungs
- Incomplete pain relief or pain recurrence if cement fails or adjacent fracture occurs
- Failure to restore height in chronic or severely collapsed fractures
Frequently Asked Questions
What is the difference between kyphoplasty and vertebroplasty?
Both procedures inject bone cement into a fractured vertebra to stabilize it. The key difference is the balloon step: kyphoplasty inflates a balloon before cement injection to create a cavity and attempt to restore vertebral height. Vertebroplasty injects cement directly into the fractured vertebra without a balloon, at higher pressure. Kyphoplasty produces better height restoration and uses lower-pressure cement injection (reducing leakage risk); vertebroplasty is slightly simpler and faster. Both produce equivalent pain relief outcomes in clinical trials.
How do I know if my fracture is recent enough for kyphoplasty to work?
MRI is the definitive test. An acute fracture shows bone marrow edema on STIR or T2-weighted MRI sequences — a bright signal indicating active injury and fluid in the bone. Chronic fractures that have fully healed or consolidated do not show this edema and typically do not respond to kyphoplasty because the fracture is stable and the cement cannot restore structure that has already remodeled. Your spine specialist will review your MRI to determine if your fracture is within the treatment window — generally within 6–8 weeks of the fracture event.
Will kyphoplasty cure my osteoporosis or prevent future fractures?
No — kyphoplasty stabilizes the current fracture but does not treat the underlying osteoporosis. Patients who undergo kyphoplasty remain at elevated risk for future vertebral fractures if osteoporosis is not treated. Starting or optimizing anti-osteoporosis medications (bisphosphonates, denosumab, or romosozumab) after recovery is essential. Fall prevention strategies, calcium and vitamin D supplementation, and appropriate physical activity also reduce future fracture risk.
How painful is recovery from kyphoplasty?
Most patients are surprised by how quick and tolerable the recovery is. The procedure itself is performed under sedation or light anesthesia, so there is no pain during the procedure. Post-procedure soreness at the needle insertion site is mild — manageable with over-the-counter analgesics for 24–48 hours. The fracture pain that brought patients to evaluation typically begins improving within 24 hours of the procedure. Many patients report the kyphoplasty recovery is far easier than the fracture pain itself.
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Medical disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with any questions you may have regarding a medical condition or surgical procedure. Last reviewed April 2026. CPT: 22513.